A 6-year prospective evaluation of a one-step HEMA-free self-etching adhesive in Class II restorations

Clinical evaluation of Giomer and self-etch adhesive compared with nanofilled resin composite and etch-and-rinse adhesive - Results at 8 years

OBJECTIVE

This study aimed to evaluate the long-term clinical performance of Giomer and a self-etch adhesive system compared with a nanofilled resin composite and etch-and-rinse adhesive system in Class I and Class II restorations.

METHOD

The study was designed to be double-blinded with intra-individual control. 48 patients with 54 pairs of cavities (class I or class II) were recruited. Each pair of restorations was placed with either BEAUTIFIL II (BF) and FL-BOND II (FL) or Filtek Z350 (Z350) and Scotchbond Multi-Purpose (SMP). Clinical evaluation was performed at baseline, 6-month, 18-month, 4-year and 8-year after placement according to modified USPHS criteria. Kaplan-Meier survival analysis and log rank tests were performed (SPSS 20.0, IBM Corporation, US) to compare the survival probability of different restorations.A generalized linear mixed model (GLMM) was adopted to assess the performance of the materials. The McNemar test was used to show significant changes for all the evaluation criteria and difference between them.

RESULTS

At the eight-year recall, 32 patients with 67 restorations were present. There were twelve restorations in total recorded as failure due to loss of retention, restoration fracture, secondary caries, tooth fracture or endodontic treatment due to pulp necrosis. The survival probabilities and calculated annual failure rate(AFR) of BF and Z350 restorations at 8-year were 87.2 % vs 87.8 % and 1.6 % vs 1.5 % respectively with no significant difference (p > 0.05)between the two materials. Over the recall time range of eight years, decreased possibility of alpha rating was observed for retention, marginal adaptation, marginal staining and surface roughness for both materials (p < 0.05). Decreased possibility of alpha rating was observed for surface staining and secondary caries for Z350 (p < 0.05) and restoration fracture for BF (p < 0.05), respectively. Comparing the two restorative systems over eight years, no significant difference was seen for linear decline of the possibility of alpha rating for any of the criteria evaluated (p > 0.05).

CONCLUSION

Giomer material and the self-etch adhesive system had comparable clinical performance with nanofilled resin composite and etch-and-rinse adhesive system over the observation period of eight years.

Evaluation of the clinical performance of GIOMERs and comparison with other conventional restorative materials in permanent teeth: a systematic review and meta-analysis

Aim The aim of this systematic review and meta-analysis was to analyse the clinical performance of GIOMER restorative composites and compare them with other conventional restorative materials in permanent teeth.Methods Searches in PubMed, Web of Science, Scopus, Ovid and Cochrane Library were conducted. Grey literature search was also performed. Clinical trials that evaluated the clinical performance of restorations with GIOMER restorative composites in permanent teeth compared to those using composite resin, glass ionomer cement, resin-modified glass ionomer cement (RMGIC) and other GIOMERs were included. Meta-analyses comparing GIOMER restorative composites with RMGIC at 6- and 12-month follow-ups and comparing two types of GIOMER were feasible.Results Ten studies fulfilled the inclusion criteria. In these studies, GIOMER was compared to different types of dental restoration materials. Dental restorations were evaluated by United States Public Health Service criteria in all included studies. Four studies were suitable for meta-analysis, which showed significant differences between GIOMER and RMGIC surface roughness at 6-month (odds ratio [OR] = 6.56; 95% confidence interval [CI] = 2.38-18.13) and 12-month (OR = 8.76; CI = 3.19-24.07) follow-ups. No significant differences between GIOMER restorative composites and RMGIC for marginal adaptation were found at 6- and 12-month follow-ups. When comparing two GIOMERs, significant differences were seen between Beautifil II and Beautifil Flowable Plus F00 for marginal staining (OR = 2.58; CI = 1.42-23.27; I2 = 0%) and surface roughness (OR = 4.59; CI = 1.11-18.97; I2 = 0%) at the 36-month follow-up. No significant differences between Beautifil II and Beautifil Flowable Plus F00 were seen for marginal adaptation and anatomic form at 6-, 18- and 36-month follow-ups.Conclusions GIOMER restorative composites presented similar performance concerning marginal adaptation and better surface roughness when compared to RMGIC. GIOMER Beautifil II presented similar performance to GIOMER Beautifil Flow Plus F00 concerning marginal adaptation and anatomic form and worse marginal staining and surface roughness when compared to Beautifil Flowable Plus F00.

Compliance of randomized controlled trials in posterior restorations with the CONSORT statement: a systematic review of methodology

OBJECTIVES

This study aims to investigate the compliance of randomized controlled trials (RCTs) in posterior restorations with the Consolidated Standards of Reporting Trials Statement (CONSORT) statement and to analyze the risk of bias (RoB) of these studies.

METHODS

A systematic search was performed in PubMed, Scopus, Web of Science, LILACS/BBO, and Cochrane Library. Only RCTs published in peer-reviewed journals were included. The compliance with the CONSORT was evaluated in a 0-2 scale where 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the CONSORT mean score by journal, country, and RoB were performed. The RoB in RCTs was evaluated by using the Cochrane Collaboration's tool version 1.0.

RESULTS

A total of 15,476 studies were identified after duplicates removal. O only 202 meet the eligibility criteria, among which 31 were follow-up studies. Concerning the overall RoB, only 29 out of 171 were classified as low risk of bias. The overall mean CONSORT score was 19 ± 5.4 points, which means compliance of approximately 59%. Significant differences among countries, publication period, and RoB were observed (p < 0.001). The journal's impact factor was not correlated with the overall CONSORT score (p = 0.36).

CONCLUSIONS

The adherence of RCTs conducted in posterior restorations to the CONSORT Statement is still low. In addition, most studies were classified as at unclear risk of bias. These results call up an urgent need for improvement.

CLINICAL RELEVANCE

Most RCTs conducted in posterior teeth have poor reporting and are mainly classified as having an unclear risk of bias.

Commercially Available Fluoride-Releasing Restorative Materials: A Review and a Proposal for Classification

Resin composite and glass ionomer cement (GIC) are the most commonly used dental materials to perform direct restorations. Both have specific characteristics that explain their popularity and their limits. More than 20 years ago, the first attempt (followed by others) to combine the advantages of these two families was performed with compomers, but it was not very successful. Recently, new formulations (also called 'smart materials') with claimed ion release properties have been proposed under different family names, but there are few studies on them and explanations of their chemistries. This comprehensive review aims to gather the compositions; the setting reactions; the mechanical, self-adhesive, and potential bulk-fill properties; and the ion release abilities of the large existing families of fluoride-releasing restorative materials and the new restorative materials to precisely describe their characteristics, their eventual bioactivities, and classify them for an improved understanding of these materials. Based on this work, the whole GIC family, including resin-modified and highly viscous formulations, was found to be bioactive. Cention N (Ivoclar Vivadent, AG, Schaan, Lietschentein) is the first commercially available bioactive resin composite.

The differences between three performance measures on dental restorations, clinical success, survival and failure: A matter of perspective

OBJECTIVES

The aim of this retrospective methodology study was to investigate the influence of using different definitions for restoration failure and inclusion criteria on restoration longevity expressed in AFR.

METHODS

EPF from fifteen general dental practices were used for collecting the data for this study. From the EPF, 321,749 composite restorations placed in 52,245 patients by forty-seven GDPs between January 2000 and December 2011 were included. Kaplan-Meier statistics were applied and mean AFRs over 2, 5 and 10 years were calculated. The effect on the AFR of using different levels of failure: based on Claims data (CD), Success (SUC), Survival (SUR) and different inclusion criteria of tooth/restoration variables were reported.

RESULTS

Highest AFRs were found for level CD, in which every intervention was considered as failure, and the lowest AFRs for level SUR in which repairs and an endodontic treatments were not considered as a failure. AFRs increased when the observation period prolonged especially for SUR, followed by SUC and CD. An overview of long-term survival studies showed a wide variation in study design, performed clinical examination (USPHS criteria or GDP), number of restorations included, description of restoration failure and found AFRs for CD, SUC and SUR.

SIGNIFICANCE

Using failure criteria, Success and Survival, in future clinical studies would enable a better comparison of studies as well as demonstrate the impact of more conservative restorative intervention protocols on patient care.

Bioactive resin-based composite with surface pre-reacted glass-ionomer filler and zwitterionic material to prevent the formation of multi-species biofilm

OBJECTIVE

This study evaluated the synergetic effect between surface pre-reacted glass-ionomer (SPRG) filler and 2-methacryloyloxyethyl phosphorylcholine (MPC), for inhibiting multi-species biofilm formation, while maintaining or even improving the original beneficial features of SPRG-filled resin-based composite (RBC).

METHODS

MPC (1.5-10wt%) was incorporated into commercial SPRG-filled RBC. Then, the inherent properties of RBC, and ion release and acid-neutralising properties associated with SPRG were investigated. Further, protein adsorptions and bacterial adhesion and viability on the SPRG-filled RBC surfaces were studied using four kinds of oral bacteria; Streptococcus mutans, Actinomyces naeslundii, Veillonella parvula, and Porphyromonas gingivalis. Finally, the thickness and biomass of the human saliva-derived biofilm model cultured on test and control samples were analysed.

RESULTS

Addition of MPC content resulted in decreased flexural strength and wettability of SPRG-filled RBC. SPRG-filled RBC released significantly higher amounts of multiple ions as contents of MPC increased. Meanwhile, SPRG-filled RBC with 5-wt% MPC significantly improved acid-neutralising properties than those of other test and control samples (P<0.001). SPRG-filled RBC with 3wt% MPC significantly reduced the amount of adsorbed bovine serum albumin and proteins from the brain heart infusion medium as compared to the control (P<0.01). A similar trend was observed in the attachment of four types of bacteria and multi-species biofilm (P<0.01).

SIGNIFICANCE

Despite limitation in terms of deteriorations of some physical properties, addition of 3% MPC to SPRG-filled RBC leads to inhibition of the attachment of multi-species bacteria on its surface, as well as inhibition of biofilm growth. Moreover, the original important bioactive features of SPRG-filled RBC such as ion release and acid neutralisations are either maintained or improved upon adding MPC.

A randomized controlled evaluation of posterior resin restorations of an altered resin modified glass-ionomer cement with claimed bioactivity

OBJECTIVE

The objective of this randomized controlled prospective clinical trial was to evaluate the short time clinical behaviour of an altered resin modified glass-ionomer cement (RMGIC), which is claimed to possess bioactivity, in posterior restorations and to compare it intraindividually with a nanofilled resin composite.

METHODS

Totally 78 pairs Class II and 4 pairs Class I restorations were placed in 29 female and 38 male participants with a mean age of 58.3 years (range 37-86). Each patient received at random at least one pair of, as similar as possible, Class II or Class I restorations. In the first cavity of each pair, the modified flowable RMGIC (ACTIVA Bioactive; AB) was placed after phosphoric acid etching of the cavity and without adhesive, according to the instructions of the manufacturer. In the other cavity a well established nanofilled resin composite (CeramX; RC) with a single step self-etch adhesive (Xeno Select) was placed. The restorations were evaluated using slightly modified USPHS criteria at baseline, 6 and 12 months. Caries risk and parafunctional habits of the participants were estimated.

RESULTS

158 restorations, 8 Class I and 150 Class II, were evaluated at the one year recalls. At baseline two failed restorations were observed (2AB), at 6 months six failures (5AB, 1RC) and at 12 months another thirteen failed restorations were observed (12AB, 1RC). This resulted in annual failure rates of 24.1% for the AB and 2.5% for RC (p<0.0001). The main reasons for failure for AB were lost restorations (5), postoperative symptoms (4) and secondary caries (3). Do to the unacceptable very high one-year failure frequency, the clinical study was stopped and no further evaluation will be performed.

SIGNIFICANCE

The use of the AB restorative in Class II cavities, applied as instructed by the manufacturer after a short phosphoric acid pretreatment but without adhesive system, resulted in a non-acceptable very high failure frequency after a one year period. Further studies should be conducted using a bonding agent.

Dentin Sealing and Bond Strength Evaluation of Hema-Free and Multi-Mode Adhesives to Biomodified Dentin

This study evaluated the effect of dentin biomodification on the bond strength (BS) and sealing ability (SA) of HEMA-free and multi-mode adhesives after 24 h and 6 months of water storage. Four adhesives were tested: two multi-mode (Scotchbond Universal - SU, and Prime & Bond Elect - PB) and two HEMA-free (All-Bond 3 - AB, and G-Aenial - GA). Human third molars were selected and dentin was treated with two cross-linking agents (5% glutaraldehyde and 6.5% proanthocyanidin-rich grape seed extract - PACs) for 10 min or kept untreated (control group) (n=6). Teeth were sectioned and prepared for BS test and SA analysis. The SA measurements were taken with the presence of smear layer (minimum permeability), EDTA treatment (maximum permeability), PACs application, adhesive application and after 6 months of water storage. BS data were analyzed by Proc Mixed and Tukey-Kramer test (α=5%). PACs application increased the BS for all adhesives tested at 24 h. However, BS decreased for SU and AB after six months. In general, multi-mode adhesives (SU and PB) did not differ from AB HEMA-free. GA presented the lowest BS values at both times of evaluation. Dentin permeability was reduced after PACs application and remained the same after 6 months, regardless adhesive application. PACs can increase the BS regardless the type of adhesive, however only for PB and GA the BS kept stable after 6-months of water storage. PACs was able to seal the dentin as the minimum permeability and also remained stable after 6 months.

Durability of a low shrinkage TEGDMA/HEMA-free resin composite system in Class II restorations. A 6-year follow up

OBJECTIVE

The objective of this randomized controlled prospective trial was to evaluate the durability of a low shrinkage and TEGDMA/HEMA-free resin composite system in posterior restorations in a 6-year follow up.

METHODS

139 Class II restorations were placed in 67 patients with a mean age of 53 years (range 29-82). Each participant received at random two, as similar as possible, Class II restorations. In the first cavity of each pair the TEGDMA/HEMA-free resin composite system was placed with its 3-step etch-and-rinse adhesive (cmf-els). In the second cavity a 1-step HEMA-free self-etch adhesive was used (AdheSe One F). The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 6 years. Caries risk and parafunctional habits of the participants were estimated.

RESULTS

Three molar teeth showed mild post-operative sensitivity during 3 weeks for temperature changes and occlusal forces. After 6 years, 134 Class II restorations were evaluated. Twenty-one restorations, 8 cmf-els (11.4%) and 13 ASE-els (20%) failed during the 6 years (p<0.0001). The annual failure rates were 1.9% and 3.3%, respectively. The main reasons for failure were fracture followed by recurrent caries. Most fractures and all caries lesions were found in high risk participants.

SIGNIFICANCE

The Class II resin composite restorations performed with the new TEGDMA/HEMA-free low shrinkage resin composite system showed good durability over six years.

Bulk-filled posterior resin restorations based on stress-decreasing resin technology: a randomized, controlled 6-year evaluation

This randomized study evaluated a flowable resin composite bulk-fill technique in posterior restorations and compared it intraindividually with a conventional 2-mm resin composite layering technique over a 6-yr follow-up period. Thirty-eight pairs of Class II restorations and 15 pairs of Class I restorations were placed in 38 adults. In all cavities a single-step self-etch adhesive (Xeno V) was applied. In the first cavity of each pair, the flowable resin composite (SDR) was placed, in bulk increments of up to 4 mm. The occlusal part was completed with a layer of nanohybrid resin composite (Ceram X mono). In the second cavity of each pair, the hybrid resin composite was placed in 2-mm increments. The restorations were evaluated using slightly modified US Public Health Service (USPHS) criteria at baseline and then annually for a time period of 6 yr. After 6 yr, 72 Class II restorations and 26 Class I restorations could be evaluated. Six failed Class II molar restorations, three in each group, were observed, resulting in a success rate of 93.9% for all restorations and an annual failure rate (AFR) of 1.0% for both groups. The AFR for Class II and Class I restorations in both groups was 1.4% and 0%, respectively. The main reason for failure was resin composite fracture.

Four-year outcomes of restored posterior tooth surfaces-a massive data analysis

OBJECTIVES

There is only sparse knowledge concerning the outcomes of treatments with posterior permanent restorations in general practice settings. This study aimed at evaluating outcomes based on a large dataset by using a novel approach on a tooth surface basis.

MATERIALS AND METHODS

The study based on routine data from a major German national health insurance company. Respective treatment fee codes allowed for tracking the clinical courses on a tooth surface level. The study intervention was defined as the placement of a restoration on an interproximal or occlusal posterior tooth surface regardless of its actual extension and material on which no information was available. All surfaces restored between January 1st, 2010 and December 31st, 2013 were included. Kaplan-Meier survival analyses were conducted to estimate four-year survival. The primary outcome was a restorative re-intervention on the same tooth surface. Separate analyses were performed for the secondary outcomes "crowning" and "extraction".

RESULTS

Over ten million interproximal surfaces and eight million occlusal surfaces in nine million posterior teeth had been restored. At 4 years, the cumulative survival rates concerning the primary outcome "re-intervention" for mesial surfaces (81.4%; CI 81.3-81.5%) and distal surfaces (81.2%; CI 81.1-81.2%) differed significantly from those for occlusal surfaces (77.0%; CI 76.9-77.0%). Restored surfaces in premolars showed significantly higher survival rates compared to molars. Four-year survival rates for the secondary outcome "crowning" were 91.9% (CI 91.8-91.9%) for mesial surfaces, 92.1% (CI 92.1-92.2%) for distal surfaces and 93.3% (CI 93.2-93.3%) for occlusal surfaces. The respective rates for the secondary outcome "extraction" were 94.5% (CI 94.5-94.5%) for mesial surfaces, 94.8% (CI 94.7-94.8%) for distal surfaces and 95.4% (CI 95.4-95.5%) for occlusal surfaces.

CONCLUSIONS

Re-interventions after restorative treatment play a significant role in general practice settings. Surface-related survival rates of restorations reveal a need for improvement.

CLINICAL RELEVANCE

This study allows the estimation of the probability of re-interventions after restoring posterior tooth surfaces. It is based on several million cases from general practises under the terms and conditions of a national health insurance system.

Marginal integrity of low-shrinking versus methacrylate-based composite: effect of different one-step self-etch adhesives

The aim of the study was to evaluate the influence of composite type and adhesive system on the quality of marginal adaptation in standardized Class V cavities before and after thermo-mechanical loading (TML). The cavities were restored using different combinations of three adhesive systems [(Silorane System Adhesive (SSA), Clearfil S³ Bond (S3), G-Bond (G-B)] and two resin composite materials (Filtek Silorane, Clearfil AP-X). Six groups (n = 10): Group A (SSA-Primer + SSA-Bond, Filtek Silorane), Group B (SSA-Primer + SSA-Bond, Clearfil AP-X), Group C (S3 + SSA-Bond, Filtek Silorane), Group D (S3 + SSA-Bond, Clearfil AP-X), Group E (G-B + SSA-Bond, Filtek Silorane) and Group F (G-B + SSA-Bond, Clearfil AP-X) were defined. Marginal adaptation was assessed on replicas in the SEM at 200 × magnification before and after TML (3000 × 5-55 °C, 1.2 10⁶ × 49 N; 1.7 Hz) under simulated dentinal fluid. The highest scores of continuous margins (%CM) were observed in the group F (G-B + SSA-Bond, Clearfil AP-X: before loading 96.4 (±3.2)/after loading 90.8 (±7.0)). A significant effect of adhesive system, composite type and loading interval was observed on the results (p < 0.05). Significantly lower scores of %CM were observed for silorane-based composite (Filtek Silorane) after TML in comparison with methacrylate-based composite (Clearfil AP-X) considering total marginal length (p < 0.05). For both Filtek Silorane and Clearfil AP-X, G-Bond performed significantly better than SSA-Primer and Clearfil S³ Bond (p < 0.05). For all combinations of one-step self-etch adhesives and SSA-Bond resin coating, silorane-based low-shrinking composite exhibited inferior marginal adaptation than did the methacrylate-based composite.

Restoration Survival: Revisiting Patients' Risk Factors Through a Systematic Literature Review

A literature review was conducted to investigate the influence of patient-related factors on restoration survival in posterior permanent teeth as well as to report the methods used to collect these factors. The selection of articles on longitudinal clinical studies investigating the survival of posterior restorations (except full crowns and temporary fillings) and including patient-related factors was performed by applying predefined criteria. The review was organized into two parts, the first describing how patient factors were assessed in the studies (n=45) and the second presenting the statistical significance (n=27) and size of the effect (n=11) of these factors on restoration survival. Patient-related factors mentioned in the studies included age; gender; caries risk; caries activity/severity; decayed, missing, filled teeth; number of restorations; oral hygiene; and bruxism, among others. Sixteen studies included the patient age or age range in the analysis, which was found to be significant in 47% of the studies. Regarding gender, four of 17 reports found a significant effect on survival, showing more failures for men in three studies. The caries risk profile or related variables were included in the analysis of 15 studies, and a significant effect on survival was reported for high-caries-risk individuals (or related variables) in 67% of these studies. Bruxism was also found to influence restoration survival in three of six studies where this variable was investigated. Some issues were found regarding the reporting of methods used to classify patients according to risk and were thoroughly discussed. In view of the information gathered in this review, the assessment of patient factors along with other variables should become part of clinical studies investigating restoration survival, since several of these factors were shown to influence the failure of restorations, regardless of the material type.

A 3-year randomized clinical trial evaluating two different bonded posterior restorations: Amalgam versus resin composite

Objective:

To compare the performance and postoperative sensitivity of a posterior resin composite with that of bonded amalgam in 40 (n = 20) large sized cavities and to evaluate whether resin composite could be an alternative for bonded amalgam.

Materials and Methods:

This was a randomized clinical trial. Twenty patients in need of at least two posterior restorations were recruited. Authors randomly assigned one half of the restorations to receive bonded amalgam and the other half to composite restorations. Forty bonded amalgams (n = 20) and composites (n = 20) were evaluated for their performance on modified-US Public Health Service criteria and postoperative sensitivity using visual analogue scale (VAS) for 36-months.

Results:

Success rate of this study was 100%. First clinical alterations were rated as Bravo after 1 year in marginal discoloration, marginal adaptation, anatomical form, and surface roughness for both amalgam and composite. At the 3^rd year, overall “Bravo” rated restorations were 12 for bonded amalgam and 13 for resin composites. There were no significant differences among the VAS scores of composites and bonded amalgams for all periods (P > 0.05) except for the comparisons at the 3^rd year evaluation (P < 0.05).

Conclusions:

Within the limitation of this study, both resin composite and bonded amalgam were clinically acceptable. Postoperative sensitivity results tend to decrease more in composite restorations rather than amalgams. Therefore, it was concluded that posterior resin composite can be used even in large sized cavities.

A randomized controlled 27 years follow up of three resin composites in Class II restorations

OBJECTIVE

To evaluate the durability of three conventional resin composites in Class II restorations during 27 years.

METHODS

Thirty participants, 25 female and 5 male (mean age 38.2 years, range 25-63), received at least three (one set) as similar as possible Class II restorations of moderate size. The three cavities were chosen at random to be restored with a chemical-cured (Clearfil Posterior) and two visible light-cured resin composites (Adaptic II, Occlusin). A chemical-cured enamel bonding agent (Clearfil New Bond) was applied after Ca(OH)2 covering of dentin and enamel etch. Marginal sealing of the restorations was performed after finishing. One operator placed 99 restorations (33 sets). Evaluation was performed with slightly modified USPHS criteria at baseline, 2, 3, 10 and 27 years.

RESULTS

Postoperative sensitivity was observed in 5 patients. Three participants with 11 restorations (11%) could not be evaluated at the 27 year recall. Thirty-seven restorations failed (13 AII, 10 CP and 14 O). The overall success rate after 27 years was 56.5% (AII 55.2%, CP 63.0%, O 51.7%; p=0.70), with an annual failure rate of 1.6%. The main reason for failure was secondary caries (54.1%), followed by occlusal wear (21.6%) and material fracture (18.9%). Non-acceptable color match was seen in 24 (28.3%) of the restorations (AII 2, CP 16, O 6). Cox regression-analysis showed significant influence of the covariates tooth type, caries risk, and bruxing activity of the participants.

CONCLUSIONS

Class II restorations of the three conventional resin composites showed an acceptable success rate during the 27 year evaluation.

A randomized controlled 30 years follow up of three conventional resin composites in Class II restorations

OBJECTIVE

The aim of this 30 year randomized controlled study was to evaluate, by intraindividual comparisons, the durability of three conventional resin composites in Class II restorations.

METHODS

Each of 30 participants, 21 female and 9 male (mean age 30 years, range 20-43), received at least three (one set) as similar as possible Class II restorations of moderate size. After cavity preparation, the three cavities were chosen at random to be restored with two chemical-cured (P10, Miradapt) and one light-cured resin composite (P30). A chemical-cured enamel bonding agent was applied after etching of the enamel. The chemical-cured resin composites were placed in bulk and the light-cured in increments. One operator placed 99 restorations (33 sets). The restorations were evaluated with slightly modified USPHS criteria at baseline, 2, 3, 5, 10, 15, 20 and 30 years. Statistical analyses were performed by the Kaplan-Meier, log-rank test and Cox regression analyses.

RESULTS

After 30 years, 5 participants with 15 restorations (15%) could not be evaluated during the whole evaluation. Seven participants were considered as caries risk and eight participants as having active parafunctional habits. Postoperative sensitivity was observed in 24 teeth. In total 28 restorations, 9 P10, 12 P30 and 7 Miradapt restorations failed during the 30 years. The main reasons for failure were secondary caries (39.2%) and material fracture (35.7%). Sixty-four percent of the secondary caries lesions were found in high caries risk participants and 70% of the material fractures occurred in participants with active parafunctional habits. The overall success rate at 30 years was 63%, with an annual failure rate of 1.1%. 68-81% of the restorations showed non-acceptable color match. No statistical significant difference in survival rate was found between the three resin composites (p=0.45). The variables tooth type, cavity size, age, and gender of the participants did not significantly affect the probability of failure.

SIGNIFICANCE

The three conventional resin composites showed good clinical performance during the 30 year evaluation. The chemical cured resin composites showed better performance than the light-cured composite.

Does the adhesive strategy influence the post-operative sensitivity in adult patients with posterior resin composite restorations?: A systematic review and meta-analysis

OBJECTIVES

A systematic review and meta-analysis were performed on the risk and intensity of postoperative sensitivity (POS) in posterior resin composite restorations bonded with self-etch (SE) and etch-and-rinse (ER) adhesives.

SOURCE

A comprehensive search was performed in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The abstracts of the annual conference of the IADR (1990-2014), unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periodicos Capes Theses databases.

STUDY SELECTION

We included randomized clinical trials that compared the clinical effectiveness of SE and ER used for direct resin composite restorations in permanent dentition of adult patients. The risk/intensity of POS was the primary outcome. The risk of bias tool of the Cochrane Collaboration was used. The meta-analysis was performed on the studies considered 'low' risk of bias.

DATA

After duplicates removal, 2600 articles were identified but only 29 remained in the qualitative synthesis. Five were considered to be 'high' risk of bias and eleven were considered to be 'unclear' in the key domains, yielding 13 studies for meta-analysis. The overall relative risk of the spontaneous POS was 0.63 (95% CI 0.35 to 1.15), while the stimuli-induced POS was 0.99 (95% CI 0.63 to 1.56). The overall standardized mean difference was 0.08 (95%CI -0.19 to 0.35). No overall effect was revealed in the meta-analyses, meaning that no influence of the ER or SE strategy on POS.

SIGNIFICANCE

The type of adhesive strategy (ER or SE) for posterior resin composite restorations does not influence the risk and intensity of POS. CRD42014006617.

Survival of direct resin restorations in posterior teeth within a 19-year period (1996-2015): A meta-analysis of prospective studies

OBJECTIVES

The aim of this study is to analyze the survival of posterior composite restorations published within the last 19 years (1996-2015).

METHODS

In this study only prospective, clinical trials with specification of the failure rate according to Class I/II composite fillings were included. Studies were analyzed according to the observation period (all studies vs. short-term vs. long-term studies). Retrospective studies and/or open laminate studies, tunnel restorations and Class V restorations were excluded. The following variables possibly influencing the failure rate were extracted from the studies: observation period, recall rate, average age of patients, number of patients, ratio of Class I/II fillings, number of restorations, ratio of premolars/molars, operator, method of isolation, bonding generation and filler size.

RESULTS

A total of 88 studies were included for statistical analysis. The observation period of the studies varied between 1 and 17 years, while most of the studies did not last longer than 5 years. Fracture of the restorations, secondary caries and marginal gap are the main causes for failure in the first 5 years (in descending order), while fracture and secondary caries are similarly distributed in long-term studies. Variables of investigation differed greatly in significance according to the respective observation period. The observation period, the recall rate, the ratio of Class I/II fillings and the number of restorations and patients had a significant influence on the overall failure rate when including all studies (short- and long-term). A linear correlation between the observation period and the failure rate was observed. In long-term studies these variables were not significant any longer. No significant difference in the failure rates between the materials per study was observed. The most common commercial composites investigated were: Tetric Ceram, Surefil, Filtek Supreme (incl. XT), Filtek Z250. The mean annual failure rate was 1.46% (±1.74%) for short-term studies and 1.97% (±1.53) for long-term studies. There is still a big need for clinical studies lasting longer than 5 years, as failure rates of composite restorations in posterior teeth increases with longer observation periods.

SIGNIFICANCE

A decreasing failure rate with an increasing recall rate as observed in our study suggests a patient selection in regard to availability and dental awareness. Internationally standardized evaluation criteria are mandatory in order to allow comparisons of the outcomes of clinical studies.

Retrospective evaluation of posterior direct composite restorations: 10-year findings

OBJECTIVES

This 10-year retrospective study investigated the differences in the changes and the longevity of Class II restorations using 4 similar microhybrid resin composites (Filtek Z250, Herculite XR, Gradia Direct Posterior, Renew).

METHODS

Data were collected from patient records. Those patients who received posterior restoration between 2001 and 2003, and who still visited the clinical practice for regular check-up visits were selected. A total of 225 adult patients (86 males, 139 females) with 701 restorations were evaluated by 2 operators using the USPHS criteria. Data were analyzed with Fisher's Exact Test, Pearson's Chi-Square Test and Kaplan-Meier analysis (p<0.05).

RESULTS

A failure rate of 2.1% was detected. The reasons of failures included restoration fracture, secondary caries and endodontic treatment. Similar survival rates for Gradia Direct Posterior (91.25%) and Renew (92.19%) were observed; better performance was observed with the Filtek Z250 (99.1%) and Herculite XR (98.64%). There was a higher probability of failure in 3 surface (n=10) than in 2 surface (n=5) restorations (p<0.001), and this rate was similar when molars (n=8) and premolars (n=7) were compared. The most frequent but clinically acceptable deficiency was the marginal discoloration.

SIGNIFICANCE

All four microhybrid resin composites showed acceptable clinical durability in Class II restorations during the 10-year follow-up period, with an overall survival rate of >97.8%. Higher rates of failures and deficiencies were observed with the Renew (fracture) and Gradia Direct Posterior (color match), respectively.